Acute Kidney Injury (AKI)

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Introduction

This leaflet gives you general information about your condition. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is acute kidney injury (AKI)

Acute Kidney Injury is the term used describing when your kidneys stop working properly over a short period of time, usually a few days or weeks. Healthy kidneys remove waste products and excess fluid from the body via the urine. AKI occurs when there is a build-up of waste products and excess fluid in the body that makes people unwell. The kidneys can be very badly damaged without symptoms being experienced or reduction in the amount of urine being produced. Blood tests are needed to diagnose and monitor kidney function.

What causes acute kidney injury?

Often several factors combine to cause AKI. Important risk factors for AKI are listed below:

Age – AKI is more common in older people

Diabetes

Vascular disease – a history of heart disease, stroke or mini-stroke or other major circulation problems

Chronic Kidney Disease (CKD) – a history of gradual loss of kidney function over a prolonged period of time

Medications – some medications can increase the risk of AKI in certain situations or individuals (eg some blood pressure drugs and anti-inflammatory pain relief medication). Although these medications may be required for a health condition, alternative medications may need to be considered. Medication is discussed in more detail later on in this leaflet.

These risk factors, combined with an acute illness such as diarrhoea and vomiting, can cause AKI.

Other causes of AKI can include:

very severe illnesses such as pneumonia.

a blockage to the tubes that drain urine from the kidneys to the bladder. This will have been diagnosed by a scan of the kidneys.

primary disease of the kidneys, although this is less common. If this is the case, the healthcare team will discuss this with you and will provide you with additional specific information.

What are the symptoms of acute kidney injury?

You may not have any symptoms especially in the early stages. You may notice that you produce less urine but this is not always the case.

If AKI occurs quickly and is severe you may experience:

Nausea and vomiting

Dehydration

Confusion

High blood pressure

Abdominal pain

Backache

A build-up of fluid in the body (oedema)

How is acute kidney injury treated?

The treatment you receive will depend on the cause of your AKI. Treatment may include:

fluid through a drip in your arm. You will be closely monitored with the nurses measuring how much fluid you take in each day (drinks and other fluid) and how much urine you produce.

changes to your regular medication. It is very important that you understand any changes that have been made to your medication and any changes that may be required when you leave hospital (see below).

a small operation to relieve any obstruction (blockage), if this is found in the kidneys. If so, you may need to be followed up by the urology team (kidney and bladder surgeons).

specific medicines such as steroids or other drugs which your doctors will have discussed with you.

a period of dialysis treatment (using a specialised machine). This may be needed in more severe episodes of AKI to take over the function of the kidneys whilst the underlying problem is treated. It can take some time (weeks or months) for the kidneys to improve.

What happens afterwards?

Most patients improve and become well enough to leave hospital. After an episode of AKI the kidney function may not return back to its previous level but may recover enough to be managed as an outpatient. Kidney function often needs to be monitored by your GP or practice nurse by regular blood tests, urine tests and blood pressure checks. By attending for any monitoring tests that we recommend, you can reduce the risk of developing another episode of AKI.

We will write to your GP with details of your admission but you may also wish to inform your GP practice. Changes may have been made to your regular medicines. When you are discharged you should discuss these changes with your GP.

If you are still working or have any travel plans in the near future please ask for advice about this before leaving the ward.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact Ward 50 on Tel no: (01482) 675050. In the longer term: If you are being followed up in the kidney clinic, you will be able to obtain advice from your Consultant. Please contact the hospital on (01482) 875875 and ask to speak to your Consultant’s Secretary. If you are not being followed up in the kidney clinic, please contact your GP for advice.

Are there any complications or risks?

If your kidney function does not recover completely you have developed a condition known as Chronic Kidney Disease (CKD). Depending on the severity, CKD can have consequences for your long term health. Patients with CKD usually need to take regular medications. If this is the case, there are more detailed patient information resources that we will share with you.

Anyone who has had an episode of AKI is at a higher risk of it happening again compared to those who have not. If this happens to you, we will be able to give you an idea of the risk to you personally and what can be done to reduce the risk.

What can I do to reduce the risk of developing acute kidney injury?

By attending for any monitoring tests that we recommend you can help reduce the risk of developing another episode of AKI.

Any illness or situation that leads to dehydration and/or low blood pressure can put you at risk of AKI, eg diarrhoea or vomiting. If you are aware of this you can often reduce the risk. By maintaining fluid intake or seeking medical advice you can reduce the chances of AKI developing.

If you have had an episode of AKI we advise that you consider a temporary stop to certain tablets if you suddenly become unwell. This is called a ‘medicine holiday’ and must be discussed with your kidney specialist or with your own doctor first. The tablets that we suggest you consider stopping at such times include blood pressure tablets, anti-inflammatory pain relief and water tablets.

We have started the following new medicines

We have stopped the following medicines. Please do not start these when you get home unless you receive specific instructions to do so.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

you must be able to give your consent

you must be given enough information to enable you to make a decision

you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.